51. Long-term effect of subthalamic and pallidal deep brain stimulation for status dystonicus in children with methylmalonic acidemia and GNAO1 mutation
- Author
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Miryam Carecchio, Margherita Nosadini, Domenico D'Avella, Alberto Benato, Andrea Landi, Francesco Paoloni, Alberto Burlina, Stefano Sartori, and Angelo Antonini
- Subjects
0301 basic medicine ,Deep brain stimulation ,Adolescent ,medicine.medical_treatment ,Deep Brain Stimulation ,Methylmalonic acidemia ,GTP-Binding Protein alpha Subunits, Gi-Go ,Globus Pallidus ,GNAO1 ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Basal Ganglia Diseases ,Subthalamic Nucleus ,Basal ganglia ,medicine ,Humans ,Status dystonicus ,Child ,Amino Acid Metabolism, Inborn Errors ,Biological Psychiatry ,Dystonia ,Subthalamic nucleus ,business.industry ,medicine.disease ,nervous system diseases ,Psychiatry and Mental health ,surgical procedures, operative ,030104 developmental biology ,nervous system ,Neurology ,Anesthesia ,Cohort ,Mutation ,Female ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Status dystonicus (SD) is a rare and potentially life-threatening condition requiring intensive care management. Deep brain stimulation (DBS) has emerged as an effective treatment for SD refractory to medical management, but its application in this field is still limited. Here, we report the long-term outcome of four pediatric patients treated with DBS at the University Hospital of Padua, Italy, for SD refractory to medications. In addition, we present the results of a systematic literature review aimed at identifying published cases of SD treated with DBS, with focus on motor outcome. In our cohort, two children were affected by methylmalonic acidemia and suffered acute basal ganglia lesions, while the other two carried a pathogenic mutation in GNAO1 gene. DBS target was subthalamic nucleus (STN) in one case and globus pallidus internus (GPi) in three. All patients experienced SD resolution within 8–19 days after surgery. Mean post-operative follow-up was 5 years. We identified in the literature 53 additional SD cases treated with DBS (median age at DBS implantation: 12 years) with reported positive outcome in 51 and resolution of SD in a mean of 17 days after surgery. Our findings indicate that DBS is an effective treatment for SD refractory to medications, even in patients with acute basal ganglia lesions; STN can be an appropriate target when GPi is damaged. Moreover, data from long-term follow-up show that SD recurrences can be significantly reduced in frequency or abolished after DBS implantation.
- Published
- 2019